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20 Oct 2017

The Victorian parliament is in the final stages of debating its Voluntary Assisted Dying Bill. So is the Victorian community, and the Australian community.

Events in Spring Street are being watched very closely nationally and internationally, and with good reason.

There is a VAD bill before the NSW parliament, and a parliamentary committee on euthanasia and physician-assisted suicide has been established in Western Australia. A bill was defeated in Tasmania this year, and another on the Speaker’s vote in South Australia last year. There is a citizens-initiated referendum before the Finnish parliament.

The bill has implications well beyond the state of Victoria.

I do not envy the task before MPs in Victoria. These are difficult, deeply vexed and potentially very divisive issues.

I know this, having helped guide the Australian Medical Association through its routine revision of its policy on EPAS, first as chairman of its ethics committee, then as president when we released our statement last year.

The AMA’s statement contains several key points. Most important, it is a positive piece, an advocacy document that calls for better end-of-life care. It calls for better education of the community on advanced care planning and the “doctrine of double effect” — that is, the notion that a death hastened by a treatment to ease suffering does not constitute euthanasia.

Importantly, it calls for much greater investment in palliative care.

There are similar sentiments in recommendations one to 48 of the Victorian upper house committee inquiry into end-of-life choices. Overall, this is a good report, but it was written by a group of parliamentarians known to favour EPAS. MPs did not visit jurisdictions that had elected not to implement euthanasia. They would have done well to read the detailed and careful deliberations of the House of Lords in Britain.

It is so important that conversations on EPAS do not fail to take into account the impact such laws would have on the rest of the health system and society as a whole.

The AMA’s statement acknowledges the diversity of opinion in the community. It acknowledges the diversity of opinion within the medical profession.

But at its heart is a clear statement that “doctors should not be involved in interventions that have as their primary intention the ending of a person’s life”.

I do not doubt the compassion or motives of most people promoting the bill in Victoria. I have heard numerous moving stories of the helplessness people feel when they watch a loved one die.

Compassion is what drives doctors. It is at the heart of our code of ethics. I do not lack compassion for those who have watched a loved one die.

We have all experienced loss. Many of us have suffered the tragedy of watching a parent, child or spouse die. This grief never leaves people. It informs their opinions.

However, highly emotional stories of the grief felt subsequent to watching a loved one die do not constitute an intellectual argument in favour of EPAS.

The Victorian parliament has other opportunities to improve the end-of-life care it provides its citizens. That people suffer painful or prolonged deaths should be a clarion call to improve end-of-life care.

It should not, and must not, be an admission of failure that prompts a desperate decision to legislate EPAS.

Much has been made of the 68 protections in the VAD Bill. The bill has infuriated many euthanasia advocates because of its narrow scope.

It is not inevitable that legislation will be extended across time. The law in the US state of Oregon is roughly similar to the original legislation passed there.

But in many other legislatures euthanasia laws subsequently have been expanded to cover patients with dementia, disability and mental illness, and children.

At the recent World Medical Association meeting in Chicago, we endorsed what was only the fourth editorial revision of the 1947 Declaration of Geneva. At the heart of medical ethics is the sanctity of human life.

It is not surprising that 107 of 109 national medical associations affiliated with the WMA have statements opposing EPAS. This includes the US and Germany, nations with one form or another of EPAS law.

Euthanasia and physician-assisted suicide are at odds with modern and ancient codes of medical ethics. Every life is precious: the 10-year-old boy in Roebourne with foetal alcohol spectrum disorder and severe autism, the 36-year-old veteran with post-traumatic stress disorder, the 68-year-old woman in Morwell with metastatic cancer and no children to be with her as she dies.

I do not seek to diminish or demean the opinions of those doctors who hold a different view to AMA policy. This debate is vexed. It is difficult.

But the AMA’s position statement — which I was elected to prosecute, protect and promote — is the result of thousands of hours of work supported by generations of wisdom and ethics.

It is appropriate that parliaments, not doctors, make laws on behalf of their citizens. I wish MPs in Victoria peace and wisdom in their deliberations.

If they decide collectively to vote down the bill before them, they will have made a better and safer Victoria.

Michael Gannon 


Published: 20 Oct 2017